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Medical Male Circumcision and Associations Among Sexually Transmitted Infections Service Attendees

  • Tendesayi KufaEmail author
  • Frans Radebe
  • Venessa Maseko
  • Adrian Puren
  • Ranmini Kularatne
Original Paper

Abstract

Medical male circumcision (MMC) is a proven intervention for preventing HIV acquisition among males. We describe the circumcision status, eligibility for MMC referral and associations with HIV positivity among symptomatic males attending sexually transmitted infections (STI) services. This study was a secondary analysis of cross-sectional data collected during sentinel surveillance for STI aetiologies. In the sentinel surveillance conducted at primary care facilities located in six South African provinces, an anonymous questionnaire was administered followed by collection of appropriate genital and blood specimens for laboratory testing including HIV, rapid plasma reagin (RPR) and HSV-2 serological testing. During analysis, multivariable logistic regression was used to determine association between prevalent HIV infection and male circumcision among males who were HSV-2 AND/OR RPR serology positive and among those who were negative. A total of 847 males were included the analysis, among whom the median age was 28 years (IQR 24–32 years) with 26.3% aged < 25 years. Of these, 166 (19.6%) were medically circumcised, 350 (41.4%) traditionally circumcised while 324 (39%) were not circumcised. The yield of assessment for MMC referral was 27.7%. Overall HIV positivity was 23.1%. Compared to no circumcision, MMC had a statistically insignificant 62% lower odds of being HIV positive –among males who were HSV-2 and RPR negative- adjusted odds ratio [aOR] 0.38 [95% confidence interval (CI) 0.12–1.18], p = 0.094. Among those HSV-2 AND/OR RPR positive, MMC had a statistically insignificant 26% lower odds of being HIV positive- aOR 0.74 (95% CI 0.41–1.36), p = 0.334. In both groups HIV positivity increased with age but was positively associated with condom use at last sexual encounter [aOR 3.41 (95% CI 1.43–8.15)] and previous treatment for an STI syndrome [aOR 3.81 (95% CI 1.60–9.05)] among those HSV-2 and RPR negative. High HIV positivity and high yield of eligibility for VMMC referral among males attending STI services points to the need for better integration of HIV prevention and treatment with STI care.

Keywords

Male circumcision HIV Sexually transmitted infections 

Notes

Acknowledgements

The authors would like to acknowledge Dr Vanessa Quan and Dr Linda Erasmus from the NICD GERMS team for operational support during fieldwork, surveillance officers Ms. Valencia Kekana, Mr. Alex Vezi, Ms. Thembisa Makaleng, Ms. Bulele Makaleni, Ms. Badikazi Matiwane and Ms. Khasi Mawasha for data collection, Ms Thabitha Mathega and Ms. Gloria De Gita for data entry and management.

Funding

The surveillance activities during which the data were collected and the secondary data analysis described in the manuscript were funded by the National Department of Health in South Africa through core funding to National Institute for Communicable Diseases (NICD). The funder had no role in the design of the study, data collection, data analysis or interpretation. All authors have no conflict of interests to declare.

Supplementary material

10461_2019_2729_MOESM1_ESM.xlsx (181 kb)
Supplementary material 1 (XLSX 180 kb)

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Centre for HIV and STIs, National Institute for Communicable DiseasesJohannesburgSouth Africa
  2. 2.School of Public HealthUniversity of the WitwatersrandJohannesburgSouth Africa
  3. 3.Department of Virology, School of Pathology, Faculty of Health SciencesUniversity of the WitwatersrandJohannesburgSouth Africa
  4. 4.Department of Clinical Microbiology, School of Pathology, Faculty of Health SciencesUniversity of the WitwatersrandJohannesburgSouth Africa

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